The US's decision to halt most foreign aid this year has been a “systemic shock” to the fight against AIDS, according to officials from the United Nations who said there could be more than four million AIDS-related deaths and six million more HIV infections by 2029 if the US funding is not replaced.
Years of US-led investment into AIDS programmes has reduced the number of people killed by the disease to the lowest levels seen in more than three decades, and provided life-saving medicines for some of the world’s most vulnerable.
But in the last six months, the sudden withdrawal of US money has threatened that progress, UNAIDS said in a report released Thursday.
“The current wave of funding losses has already destabilised supply chains, led to the closure of health facilities, left thousands of health clinics without staff, set back prevention programmes, disrupted HIV testing efforts, and forced many community organisations to reduce or halt their HIV activities,” the agency said.
UNAIDS also said that it feared other major donors might also scale back their support, reversing decades of progress against AIDS worldwide – and that the strong multilateral cooperation is in jeopardy because of wars, geopolitical shifts, and climate change.
The $4 billion (€3.4 billion) that the US pledged for the global HIV response for 2025 disappeared virtually overnight in January when US President Donald Trump ordered that all foreign aid be suspended and later moved to shutter the US aid agency.
Andrew Hill, an HIV expert at the University of Liverpool who is not connected to the UN, said that while Trump is entitled to spend US money as he sees fit, “any responsible government would have given advance warning so countries could plan,” instead of stranding patients in Africa when clinics were closed overnight.
Impact of US investment in HIV/AIDS
The US President’s Emergency Plan for AIDS Relief, or PEPFAR, was launched in 2003 by then-President George W Bush, the biggest-ever commitment by any country focused on a single disease.
UNAIDS called the programme a “lifeline” for countries with high HIV rates, and said that it supported testing for 84.1 million people, treatment for 20.6 million, among other initiatives.
According to data from Nigeria, PEPFAR also funded 99.9 per cent of the country’s budget for medicines taken to prevent HIV.
In 2024, there were about 630,000 AIDS-related deaths worldwide, per a UNAIDS estimate. That figure has remained about the same since 2022, after peaking at about two million deaths in 2004.
Even before the US funding cuts, progress against curbing HIV was uneven. UNAIDS said that half of all new infections are in sub-Saharan Africa and that more than 50 per cent of all people who need treatment but aren’t getting it are in Africa and Asia.
‘US is abandoning the fight’
The political uncertainty arrived shortly after a medical breakthrough in the fight against HIV.
Studies published last year showed that a twice-yearly injectable drug from pharmaceutical maker Gilead was 100 per cent effective in preventing the virus.
Last month, the US Food and Drug Administration (FDA) approved the drug, called Sunleca – a move that should have been a “threshold moment” for stopping the AIDS epidemic, said Peter Maybarduk of the advocacy group Public Citizen.
But activists like Maybarduk said Gilead’s pricing will put it out of reach of many countries that need it.
Gilead has agreed to sell generic versions of the drug in 120 poor countries with high HIV rates but has excluded nearly all of Latin America, where rates are far lower but increasing.
“We could be ending AIDS," Maybarduk said. “Instead, the US is abandoning the fight”.
